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Military Health System

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Outpatient Prospective Payment System

TRICARE's Outpatient Prospective Payment System (OPPS) was implemented on May 1, 2009.

Note: To minimize download times, some of these documents are being supplied in zip format as well as unzipped. You must have file compression software on your computer in order to take advantage of the zipped format.

Quarterly Updates

Payment Status by HCPCS Code


Ambulatory Payment Classifications (APCs) with Status Indicators (SIs) and Payment Rates


Payment Status Indicators


Payment Status by HCPCS Code - Drugs


Maternity Diagnosis


Annual Updates

OPPS Pricing Elements


Statewide Cost to Charge Ratios


Provider Information Updates

Zip to Wage Index Crosswalk


OPPS Provider File


Provider Types contained in the OPPS provider file:

  • 00 = Short Term Facility
  • 02 = Long Term
  • 03 = Psychiatric
  • 04 = Rehabilitation Facility
  • 06 = Hospital Distinct Parts
  • 07 = Rural Referral Center
  • 14 = Medicare Dependent Hospital
  • 15 = Medicare Dependent Hospital/Referral Center
  • 16 = Sole Community Hospital
  • 17 = Sole Community Hospital/Referral Center
  • 21 = Essential Access Hospital
  • 22 = Essential Access Hospital/Referral Center
  • 47 = Community Mental Health Centers
  • 49 = Psychiatric Distinct Part
  • 50 = Rehabilitation Distinct Part

Provider Types (download)

TRICARE Reimbursement Manual

Last Updated: May 30, 2023
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